Provider Demographics
NPI:1083230122
Name:CAMELLIA THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:CAMELLIA THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:318-794-6947
Mailing Address - Street 1:6016 PEPPER TREE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2196
Mailing Address - Country:US
Mailing Address - Phone:318-794-6947
Mailing Address - Fax:
Practice Address - Street 1:6016 PEPPER TREE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2196
Practice Address - Country:US
Practice Address - Phone:318-794-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty